Keith Ridley knows something about business, starting with the master’s in business administration from the University of Hawaii. As chief of the Department of Health Office of Health Care Assurance, he looks to see that businesses, ranging from skilled nursing facilities and hospitals to clinical laboratories and adult day care centers, comport with state regulations.
But the latest enterprise — Hawaii’s first medical cannabis dispensaries — was not only new businesses but an entirely new industry. And for the past months it’s absorbed much of his time, and that of several other state agencies trying to carve out its niche.
Deputy attorneys-general, state taxation experts (how to document and track things in a cash-only business) and others were called into duty, and that’s what took things longer than expected to set up, he said.
“I think the biggest challenge was probably, in retrospect, the unrealistic time frame expectation,” said Ridley. “This is a big deal; this is not a small-time endeavor. This takes a significant amount of work from a significant number of people, who aren’t funded by the program.”
Ridley, married with two grown children, is Hawaii born and raised. Beyond the admittedly consuming department duties, though, he finds time to play soccer in an adult league, a sport he has pursued since his school days (which also included Saint Louis High School and the University of West Florida).
Getting the dispensaries up and running marks an important benchmark, but things still need to settle down. The operators themselves, as more come on line, will need to better manage inventory; the first two dispensaries ran out of product in short order, the first week, partly because they were the only doors open, he said.
“The amount of product that would be available to the public just isn’t there unless all the others open,” Ridley added. “I think that’s No. 1.
“No. 2, I think, the facilities may have been so anxious to open, they wanted to get started with whatever they had.”
Question: Among the other areas managed by the Office of Health Care Assurance: How is the public assured of the safety of the care homes or other facilities they depend on?
Answer: A licensed facility is required to comply with licensing requirements. The department conducts a rigorous review of each license application as well as onsite inspections of facilities before granting an initial license, and thorough inspections are also required for license renewal. …
These inspection reports are available to the public, and many are posted online on the department’s website for the public to view at any time. For example, written inspection reports are posted for adult residential care homes, skilled nursing facilities, assisted living facilities, community care foster family homes, and others.
Q: Medical dispensaries have just started, but is there a department position on legalizing recreational marijuana at some point?
A: I think there are concerns. I don’t think we have really come up with a position at this point. … Certainly we’ve seen from experience in other states that recreational has presented a number of problems we would have to consider.
Q: For example, what kind of problems?
A: A number of public safety problems as well as individual health problems. An apparent increase in the number of motor vehicle accidents attributed to recreational cannabis. An increase in first-responder calls, whether it’s EMS or fire, what have you. Increased emergency room visits. And these are big concerns.
Q: The Health Department took some time to certify the laboratories for the medical marijuana testing. How did this help, and what was learned?
A: We learned from reports from other states that people were getting sick or sicker because of impurities and contaminants found in the marijuana sold in those states.
Since Hawaii’s foundational principles include patient safety and products safety, we believed independent laboratory testing was imperative as the right thing to do, and certified independent private labs were the proper way for that to happen. This meant that for the state to certify labs, labs would need to demonstrate accurate and consistent testing results on tests they perform for specific impurities and contaminants.
Impurities and contaminants include heavy metals such as lead, arsenic and mercury; solvents such as butane, benzene and others; pesticides; and visible examination would detect foreign materials such as mold, hair, insects or plastics.
Q: Are you concerned about the federal government’s current stance on marijuana? Or is the oversight likely harder on states where recreational use is legal?
A: The federal government classified marijuana a Schedule 1 drug many years ago and created laws on its illegal possession, distribution and use. We recognize the federal government can elect to enforce those laws or prioritize their enforcement.
Nevertheless, the state has created the medical cannabis program to provide certain protections under state law to patients and to provide a framework for dispensaries to cultivate, manufacture and sell medical cannabis legally. The oversight of the medical cannabis program is to ensure compliance with state law, and to ensure to the fullest extent possible a robust regulatory process aimed at preventing federal intervention.
Q: What lessons learned in other states’ dispensary setups were applied here?
A: Hawaii learned from other states the need for a more detailed and structured regulatory environment that more clearly identifies the qualifications to apply for and possess a medical cannabis dispensary license. These include background checks on applicants and dispensary employees, physical security requirements such as a secure building and security cameras, and tracking of cannabis throughout the cultivation, harvesting, manufacturing, testing, transportation and sales processes.
The need for independent laboratory testing was another lesson learned to ensure patient and product safety especially when patients are already dealing with chronic health conditions and at risk for illnesses from impurities.
Q: How is dosage to be managed by the dispensaries?
A: We expect a close relationship between the dispensaries and their patient clients.
Dispensaries will discuss dosing recommendations with the patient or caregiver based on patients’ needs and the dispensaries knowledge of their products.
We anticipate patients/caregivers will provide accurate feedback on the effects of the products. Effects could include being too mild or too strong or that a particular cannabis strain or a manufactured product such as oil or cream were ineffective.
It’s also important for patients to have a close relationship with their certifying physician and for physicians to learn more about medical cannabis and its use.
Q: Is there any pricing regulation? Any limit to what they can charge?
A: No. There are no pricing controls, no pricing regulations.
The expectation is that … obviously the price is going to have to provide the licensee the ability to recover capital investment, cover the costs of operation with their money and some profit.
But beyond that, there are no pricing controls at all. It would really be whatever the market might bear, knowing that the dispensaries would almost have to still, in a way, compete with the black market.
Q: What is your office’s chief concern in terms of gatekeeping this new industry (medical cannabis)?
A: Patient safety, product safety and public safety are our main concerns. Our regulatory responsibility is to ensure registered medical cannabis patients and licensed medical cannabis dispensaries comply with state law so that patient, product, and public safety are assured.
Q: Do you think the public accepts the medicinal value of cannabis? Do you?
A: We expect there are large segments of the public who do or do not accept cannabis as having medicinal properties or value.
Our role as regulators is to ensure compliance with state laws regardless of public or personal opinions.
